Cross Chaundre K, Shultz Delray, Malkowicz S Bruce, Huang William C, Whittington Richard, Tomaszewski John E, Renshaw Andrew A, Richie Jerome P, D'Amico Anthony V
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA.
J Clin Oncol. 2002 Jun 15;20(12):2863-8. doi: 10.1200/JCO.2002.11.054.
To compare prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for prostate cancer in African-American and white men using previously established risk groups.
Between 1989 and 2000, 2,036 men (n = 162 African-American men, n = 1,874 white men) underwent RP for clinically localized prostate cancer. Using pretreatment PSA, Gleason score, clinical T stage, and percentage of positive biopsy specimens, patients were stratified into low- and high-risk groups. For each risk group, PSA outcome was estimated using the actuarial method of Kaplan and Meier. Comparisons of PSA outcome between African-American and white men were made using the log-rank test.
The median age and PSA level for African-American and white men were 60 and 62 years old and 8.8 and 7.0 ng/mL, respectively. African-Americans had a statistically significant increase in PSA (P =.002), Gleason score (P =.003), clinical T stage (P =.004), and percentage of positive biopsy specimens (P =.04) at presentation. However, there was no statistical difference in the distribution of PSA, clinical T stage, or Gleason score between racial groups in the low- and high-risk groups. The 5-year estimate of PSA outcome was 87% in the low-risk group for all patients (P =.70) and 28% versus 32% in African-American and white patients in the high-risk group (P =.28), respectively. Longer follow-up is required to confirm if these results are maintained at 10 years.
Even though African-American men presented at a younger age and with more advanced disease compared with white men with prostate cancer, PSA outcome after RP when controlled for known clinical predictive factors was not statistically different. This study supports earlier screening in African-American men.
使用先前确定的风险组，比较非裔美国男性和白人男性前列腺癌根治术后前列腺特异性抗原（PSA）的结果。
1989年至2000年间，2036名男性（n = 162名非裔美国男性，n = 1874名白人男性）因临床局限性前列腺癌接受了前列腺癌根治术。根据术前PSA、Gleason评分、临床T分期和阳性活检标本百分比，将患者分为低风险组和高风险组。对于每个风险组，使用Kaplan-Meier精算方法估计PSA结果。使用对数秩检验比较非裔美国男性和白人男性之间的PSA结果。
非裔美国男性和白人男性的中位年龄分别为60岁和62岁，PSA水平分别为8.8 ng/mL和7.0 ng/mL。非裔美国人在就诊时PSA（P = 0.002）、Gleason评分（P = 0.003）、临床T分期（P = 0.004）和阳性活检标本百分比（P = 0.04）有统计学显著增加。然而，低风险组和高风险组中不同种族之间的PSA、临床T分期或Gleason评分分布没有统计学差异。所有患者低风险组的5年PSA结果估计为87%（P = 0.70），高风险组中非裔美国患者和白人患者分别为28%和32%（P = 0.28）。需要更长时间的随访来确认这些结果在10年时是否保持不变。
尽管与患有前列腺癌的白人男性相比，非裔美国男性就诊时年龄较轻且疾病更晚期，但在控制已知临床预测因素后，前列腺癌根治术后的PSA结果没有统计学差异。本研究支持对非裔美国男性进行更早的筛查。
